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The legal fight against " Obamacare " was
led by a group describing itself as the United States’ “leading
small business association,” and many of those worried or angry
about the health reform
law are entrepreneurs concerned that it will limit growth or
even threaten their small businesses’ existence.

That doesn’t mean, however, that small businesses uniformly
oppose the Patient Protection and Affordable Care Act, which, as
of January 2014, will require most Americans to obtain health
insurance and potentially impose hefty fees on many companies
that don’t offer their employees coverage.

The National Federation of Independent Business put its name to
the Supreme Court case that unsuccessfully sought to overturn the
health reform law. The NFIB, which has been hosting webinars on
the nuts and bolts of the new law, contends that Obamacare is a
“job-killer” that won’t restrain skyrocketing premiums that have
burdened small business for the past decade.

Some other small-business groups, however, have vocally supported
the ACA and are trying to shape its implementation, as they
expect it to significantly help both companies and employees. The
groups, for example, are resisting an Obama
administration proposal to delay a key provision of the law
that would allow small-business employees to choose from multiple
plans on state-based exchanges, or marketplaces.

Under the health reform law, employers with the equivalent of 50
or more full-time workers could face fines if they don’t provide
full-timers with affordable coverage that meets government
standards as of the first of next year. Those with fewer than 50
full-time workers won’t face those requirements and will have the
chance to sign up for plans in new state-based marketplaces and,
in some cases, receive tax credits for offering coverage.

As recently as February, an NFIB senior vice president, Susan
Eckerly, wrote to support lawmakers aiming to repeal Obamacare’s
key employer requirements. “It is already hurting employees by
forcing small business owners to reduce hours and cut jobs in
order to sustain their businesses,” she said.

NFIB also is pushing for repeal of a new health insurance tax in
the law that it estimates will cost 146,000 to 262,000
private-sector jobs and cut $19 billion to $35 billion in sales
by 2022.

Small-business supporters of the healthcare law, however,
consider the ACA a lifeline.

In testimony prepared for a South Carolina Senate panel hearing
in February, Frank Knapp Jr., president and CEO of the South
Carolina Small Business Chamber of Commerce, noted that when he
co-founded the organization in 2000, “small businesses were
begging for more affordable health insurance and health care.”

The Affordable Care Act “was the compromise solution to the
demands of businesses to get health insurance and healthcare
costs under control. And the law does,” Knapp continued, adding
that Obamacare already has resulted in health-coverage tax
credits for businesses with fewer than 25 employees while
shielding 97% of small businesses from any penalty for not
providing group insurance.

Knapp also said South Carolina small businesses were refunded
$4.3 million from insurers last year under an ACA provision that
requires at least 80% of small-business premium dollars to be
used for medical and related expenses.

A national group, the Small Business Majority, also backs the
law. In testimony submitted to the House Energy and Commerce
Committee in March, Mike Brey, a member of the Small Business
Majority’s network council, said he looked forward to the ACA
relieving the burden of rising costs that he and his toy-store
employees have seen in recent years.

Brey blamed
“misinformation and myths” for the discontent about Obamacare
among some small-business owners.

“While my business has been successful and we’ve been able to
grow, the ability to keep my workers happy and secure by
providing health insurance coverage has eroded,” Brey said,
citing premiums that have tripled over the years and rising
employee out-of-pocket costs.

“My workers are burdened by high deductibles and are putting off
preventive care for themselves and their children and avoiding
the doctor," he said. Heath reform "was the first thing in years
that gave me hope that this spiral of escalating costs and
depreciating quality of coverage might finally end."

A Small Business Majority-commissioned study by MIT economist
Jonathan Gruber found that without health reform, small employers
would pay $2.4 trillion in healthcare expenses by 2018, which
would have cost 178,000 jobs, $834 billion in small business
wages and $52.1 billion in profits.

Meanwhile, the organization recently joined several other groups,
including Silicon Valley Leadership Group, the Manhattan Chamber
of Commerce and the American Booksellers Association, in opposing
the government proposal that would allow states an extra year to
set up multiple plans on insurance exchanges. The proposal, which
also would delay “employee choice” provisions in the 33 states
with exchanges run by the federal government, is not final yet;
the Department of Health and Human Services must review public
comments received in recent weeks and likely will make a final
decision in two or three months.

The government says the delay is needed as a transitional period.
If it is approved, only one health plan would be available in
2014 to employees on affected exchanges, although employers could
select that plan from a choice of several carriers.

Knapp, of the South Carolina Small Business Chamber of Commerce,
which opposes the delay, said competitive state-based exchanges
are “something that we were selling as a benefit of the
Affordable Care Act." Small businesses would be disappointed if
that feature weren’t going to happen right away, he said.